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To investigate the diagnostic performances and unnecessary fine-needle aspiration (FNA) rates of two point-scale based TIRADS and compare them with a modified version using the ACR TIRADS’ size thresholds. Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. A total of 2106 thyroid nodules 10 mm or larger in size in 2084 patients with definitive cytopathologic findings were included. Ultrasonography categories were assigned according to each guideline. We applied the ACR TIRADS’ size thresholds for FNA to the Kwak TIRADS and defined it as the modified Kwak TIRADS (mKwak TIRADS). Diagnostic performances and unnecessary FNA rates were evaluated for both the original and modified guidelines. Of the original guidelines, the ACR TIRADS had higher specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant mKwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. The mKwak TIRADS also had a lower unnecessary FNA rate than the ACR TIRADS (54.8% and 56.4%, respectively). The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS. The modified Kwak TIRADS incorporating the size thresholds of the ACR TIRADS showed higher diagnostic performance and a lower unnecessary FNA rate than the original point-scale based TIRADS. • Of the original guidelines, the ACR TIRADS had the highest specificity, accuracy, and area under the receiver operating characteristic curve (AUC) (63.1%, 68.9%, and 0.748, respectively). • When the size threshold of the ACR TIRADS was applied to the Kwak TIRADS, the resultant modified version of Kwak TIRADS had higher specificity, accuracy, and AUC (64.7%, 70.3%, and 0.765, respectively) than the ACR TIRADS. • The false-negative rate of the Kwak TIRADS was the lowest (1.9%) among all TIRADS.

PURPOSE To systematically review (SR) and critically appraise studies that investigated the diagnostic capability of fine-needle aspiration cytology (FNAC) in the assessment of intraosseous lesions of the jaws. METHODS Six main electronic databases and three gray literature databases were searched aiming diagnostic studies, which were selected in a two-phase process. Risk of bias (RoB) of included studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. RESULTS A total of eight articles were included, of which six evaluated the FNAC smear technique exclusively, one assessed both smear and cell-block techniques, while one investigated only the cell-block technique. With regard to the FNAC smear technique, from 134 benign lesions investigated, concordance with the histopathological diagnosis was achieved in 64.17% of cases. In addition, considering the 32 malignant lesions assessed through this technique, concordance with histopathology was achieved in all cases. Regarding the cell-block technique, only benign lesions (n = 40) were evaluated in the included studies, in which the concordance rate with histopathology was of 77.5%. The overall RoB judgment was "at risk of bias" for seven included studies mostly due to lack of information or reportedly absence of blinding of evaluator. CONCLUSIONS Within the limitations of this SR, FNAC presented modest to satisfactory diagnostic capability for the assessment of intraosseous jaw lesions, showing concordance rates higher than 64% for the smear and 77% for the cell-block technique. Also, considerably high concordance rates were found for the assessment of malignant lesions regarding FNAC smear technique.

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed the guideline for primary imaging and biopsy methods in the diagnosis of thyroid nodules. The development committee, the working committee, and the advisory committee were formed to develop the recommendation. The development committee mainly plays a role of methodological consulting and overall planning and management of the advisory development stage. The working committee was composed of experts recommended by the Korean Society of Thyroid Radiology and conducted a practical adaptation process from the selection of core questions to the final recommendation. The Advisory Committee consisted of clinical experts recommended by the Korean Thyroid Association and reviewed core questions and draft recommendations and participated in the Expert Panel Survey. This guideline recommends cervical ultrasound as the first imaging modality for diagnosis of suspected thyroid nodules and recommends ultrasound-guided fine needle aspiration for histologic diagnosis of thyroid nodules. This guideline is expected to be of significant benefit to clinicians treating thyroid nodules.

Alveolar soft part sarcoma (ASPS) is a rare soft tissue neoplasm generally affecting adolescents and young adults. Its unique histologic and ultrastructural features have been well-described; however, the cytopathological features of ASPS are less well-characterized, and recognition of this entity's features on cytologic preparations can ensure that the specimen adequacy and appropriate/rapid tissue allocation for additional testing. Herein we report a FNA case of ASPS with emphasis on cytomorphologic characteristics.

International telecytology can improve patient care by increasing access to regional and international expertise in cytopathology. The majority of international telecytology studies published to date have been based on static telepathology platforms. Overall concordance rates for these studies ranged from 71% to 93%. This is comparable to the concordance rates published for other studies comparing diagnoses made by digital still images to reference glass slides, which vary from 80% to 95%. Static telepathology systems are relatively cheap and easy to use, and have the potential to increase access to international experts in developing countries with limited resources. In contrast, resource-rich academic and private medical centers can use whole slide digital imaging (WSI) for telecytology consultation, though few studies have been published addressing this topic. International telepathology consultation services with digital whole slide image capabilities have been established at several academic medical centers including the University of Pittsburgh Medical Center (UPMC) and the University of California at Los Angeles (UCLA), through the UCLA Center for Telepathology and Digital Pathology. In a small series of 20 telecytology cases submitted to UCLA from 2014 to 2017 (10 gynecologic and 10 fine needle aspiration cases), a meaningful diagnosis was rendered for 100% of cases, with 100% concordance between the submitting institution, versus consultation diagnosis provided by UCLA. These limited results are promising, and in the future both WSI and static telecytology consultation may have a place serving clinical needs in different practice settings.

Context.—Although fine-needle aspiration (FNA) practice by pathologists is now well established, it has been primarily performed by manual palpation. In recent years, pathologists have begun to venture into ultrasound-guided FNAs (UGFNAs). Reports on experiences with this relatively new technique for pathologists have shown promising results. However to date, there have been few studies in the literature comparing pathologist-performed UGFNA with the more traditional pathologist-performed palpation-guided FNA (PGFNA).Objective.—To compare UGFNA to PGFNA by cytopathologists at an academic medical center.Design.—A retrospective study of FNAs performed by cytopathologists within the University of California, Los Angeles (UCLA) pathology departmental FNA clinic was performed. Data collected included performance technique (UGFNA versus PGFNA), lesion site and size, adequacy status (nondiagnostic rate), and number of passes per procedure. Corresponding surgical pathology/flow cytometric/cytogenetic result follow-up was compared to FNA results. Findings between UGFNA and PGFNA cases were compared.Results.—Of 1029 FNA cases during the study period, there were 449 UGFNA cases (43.6%) and 580 PGFNA cases (56.4%). Nondiagnostic rates with UGFNA and PGFNA were 6.7% (30 of 449 cases) and 20.7% (120 of 580 cases), respectively. Nondiagnostic rate was also significantly lower with UGFNA than with PGFNA for lesions within the thyroid (6.0% versus 33.3%), head and neck (6.6% versus 21.2%), and salivary gland (6.2% versus 17.1%), and across all nodule sizes. A total of 495 of 1029 FNA cases (48.1%) had follow-up. Discordance rate was significantly lower with UGFNA than with PGFNA (5.4% versus 12.8%).Conclusions.—This study shows improved performance characteristics of cytopathologist-performed UGFNA versus PGFNA.

The diagnosis and management of many gastrointestinal conditions has been augmented by the development of endoscopic ultrasound. Its role in the diagnosis and management of liver disease has been somewhat limited, but with the rapid development of therapeutic advancements it has quickly emerged as a useful tool in the management of complex hepatic conditions. This includes its use in the management of complications of portal hypertension as well as its use in liver lesions and cancer. In this paper, we review case studies, case series and trials for hepatic applications of endoscopic ultrasound to provide an overview of its utilization in this field and demonstrating its more novel applications for future use.

Papillary cystadenocarcinoma of the salivary gland is a rare malignant tumor and occurs in major and minor salivary glands. Papillary cystadenocarcinoma of the mandible is exceptionally rare. It is usually a low-grade destructive tumor with a papillary and cystic architecture. This case describes a unique presentation, location, and radiographic appearance of this lesion.

Resumen Antecedentes La mucormicosis pulmonar es una infeccion oportunista rara con alta mortalidad causada por hongos Mucorales. Los mas frecuentes son Rhizopus, Mucor, Lichtheimia y Rhizomucor. Caso clinico Se presenta el caso de una mujer de 56 anos con diabetes mellitus tipo 2 y enfermedad renal cronica, receptora de un trasplante de rinon cadaverico dos anos antes de su ingreso. Por este motivo recibio tratamiento inmunomodulador con timoglobulina, micofenolato de mofetilo, tacrolimus y prednisona. La paciente ingreso por un cuadro neumonico con tos, expectoracion y disnea; una tomografia computarizada mostro una lesion cavitada en el lobulo superior derecho. Con la sospecha de una aspergilosis pulmonar invasiva se comenzo un tratamiento antifungico con voriconazol, sin mejoria. Se realizo una biopsia por aspiracion con aguja fina, y en el cultivo de la misma crecio Rhizomucor pusillus. La identificacion se confirmo por PCR. A pesar del tratamiento con anfotericina B, la paciente presento hemoptisis masiva incoercible, que provoco su fallecimiento. Conclusiones La mucormicosis pulmonar es una infeccion rara que suele ser fatal en receptores de trasplante renal con terapia antirrechazo. Los mucorales producen fenomenos tromboticos, necrosis y destruccion tisular, que provocaron en nuestra paciente una hemoptisis incoercible. Es importante un diagnostico preciso que permita instaurar un tratamiento quirurgico adecuado y la administracion de anfotericina B.

Background The non-diagnostic category of the Bethesda system has a low malignancy rate; nevertheless, repeat ultrasonography-guided fine needle aspiration (US-FNA) is recommended with no consensus for follow-up intervals. Purpose To investigate whether a six-month time interval for repeat US-FNA is appropriate for non-diagnostic thyroid nodules after applying the Bethesda system. Material and Methods From January 2010 to January 2014, 322 thyroid nodules ≥10 mm with non-diagnostic results on initial US-FNA with any follow-up with US or US-FNA were included (mean age = 52.2 years ± 12.4). Clinical and US features were compared according to size change (increase, no change, decrease) and follow-up interval (Results Of the 322 nodules, 13 (4.0%) were malignant and 309 (96.0%) were benign. None of the 82 nodules with decreased size were malignant and 90.2% nodules with decreased size were found after six months. Of 175 nodules with repeat US-FNA, repeat cytology results did not differ significantly between the groups with follow-up US-FNA before and after six months ( P = 0.337). No significant differences were seen in size or extrathyroidal extension among the 13 malignant nodules according to the six-month interval (all P > 0.05), and no lateral lymph node metastasis was present. Conclusion Repeat US-FNA for initially non-diagnostic thyroid nodules can be performed at a six-month interval after initial procedure without tumor progression.

Endoscopic ultrasound-guided fine-needle aspiration is increasingly utilized for the diagnosis of pancreatic lesions. Although operator dependent, the procedure has good overall performance characteristics and is minimally invasive; however, accuracy and sensitivity are reportedly lower for pancreatic neuroendocrine tumor (PanNET) compared with the more common pancreatic ductal adenocarcinoma (pACA). The underperformance is further exacerbated by the unusual cases of PanNET presenting with variant cytomorphology. We report two separate diagnostically challenging cases: a pigmented PanNET and a clear cell PanNET. We briefly review the literature and emphasize the importance of recognizing these uncommon variants when encountered in aspirate material. Diagn. Cytopathol. 2017;45:371-378. © 2016 Wiley Periodicals, Inc.

In Reply: We read with great interest the letter by Dr Karan Madan on the application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the evaluation of undiagnosed mediastinal lymphadenopathy and masses in children. This letter is a useful complement to our

We have read the interesting paper recently published by Ali et al., March, 8 volume, 1 issue, detailing a case of pancreatic mass in a 40-year-old male presenting with important weight loss, abdominal pain, and fever for 2 weeks. He denied any other complaint, history of tuberculosis, or drugs assumption. Recently, we have observed a comparable case of pancreatic tuberculosis which in our opinion deserves a short mention, given the rarity of such presentation and the entailed diagnostic clinical and pathologic challenges, especially when dealing with patients coming from endemic areas for tuberculosis

Purpose The aim of this study was to evaluate added value and diagnostic threshold value of thyroglobulin measurement in the fine-needle aspiration washout for detecting cervical lymph node metastasis from papillary thyroid cancer on pre and postoperative patients. Materials and Methods Total 219 cervical lymph nodes from 180 patients with papillary thyroid cancer were evaluated for fine needle aspiration cytology and thyroglobulin in fine needle aspiration (FNA-Tg), using immunometric chemiluminescent assay. Eighty-six patients were preoperative and remaining 94 patients were on follow up after total thyroidectomy. Final diagnoses were made on pathology of dissected lymph nodes or follow-up examination for at least 12 months. Results One hundred and twelve metastatic lymph nodes were finally confirmed in 94 patients out of total 180 patients. Sensitivity of FNA-Tg was 99.1, 98.21, 97.20%, respectively with threshold level at 1, 10, serum Tgng/mL, which were higher sensitivity of fine needle aspiration. Combined FNA and FNA-Tg with threshold at 1, 10, 100 ng/mL raised sensitivity and specificity to 100%, respectively. All 6 lymph nodes that were false negative on FNA were correctly diagnosed as metastasis on FNA-Tg with threshold of 1, 10, 100, and serum thyroglobulin. FNA-Tg with threshold level at 100 ng/mL combined FNA showed highest sensitivity (100%) and specificity (97.56%) on preoperative patient groups among the 1, 10, 100, serum Tg threshold value. But, FNA only showed adequately high sensitivity (100%) and specificity (96.96%) on postoperative patient groups. Using receiver operating characteristic curve (ROC) curve analysis, cut off value was 57.69 in total patient, 78.66 in preoperative patient, and 32.81 in postoperative patient. Conclusion FNA-Tg combined with FNA showed excellent sensitivity and specificity. FNA-Tg showed very high sensitivity and specificity at threshold level 78.66 ng/mL in preoperative patients, but FNA-Tg had less benefit on the postoperative patient group, having high sensitivity and specificity with FNA alone.

Currently there is a major challenge to train sufficient cytopathologists and cytotechnicians in developing countries that have poor medical and pathology infrastructure. Cytology requires well trained pathologists and laboratory staff but it needs only minimal laboratory resources. Cytology can provide the material for rapid, accurate and inexpensive diagnoses of infections such as tuberculosis and of benign and malignant palpable and impalpable lesions. Cytology can achieve this in the developing world by utilizing fine needle aspiration biopsy cytology, general fluids cytology and cervical cytology, in the same manner as is currently done in the developed world where cytology specimens are used to make cytomorphological diagnoses and increasingly to provide material for the full range of ancillary testing including molecular pathology. There are a number of ways to develop sustainable training in cytology in developing countries, especially in fine needle aspiration biopsy cytology, and these are presented and discussed.

Low-cost, rapid and accurate detection technologies are key requisites to cope with the growing global cancer challenges. The need is particularly pronounced in resource-limited settings where treatment opportunities are often missed due to the absence of timely diagnoses. We herein describe a Holographic Assessment of Lymphoma Tissue (HALT) system that adopts a smartphone as the basis for molecular cancer diagnostics. The system detects malignant lymphoma cells labeled with marker-specific microbeads that produce unique holographic signatures. Importantly, we optimized HALT to detect lymphomas in fine-needle aspirates from superficial lymph nodes, procedures that align with the minimally invasive biopsy needs of resource-constrained regions. We equipped the platform to directly address the practical needs of employing novel technologies for "real world" use. The HALT assay generated readouts in

The time between the moment of referral for the diagnostic workup for thyroid nodules and the outcome can be worrisome for patients. In general, patients experience high levels of anxiety during the evaluation of a lesion suspicious for cancer. Therefore, the implementation of same-day fine-needle aspiration cytology (FNAC) diagnosis is becoming standard-of-care for many solid tumors. Our aim was to assess the feasibility of same-day FNAC diagnosis for thyroid nodules and to assess patient anxiety during the diagnostic process.For feasibility of same-day FNAC diagnosis, we assessed the proportion of patients receiving a diagnosis at the end of the visit. Accuracy was measured by comparing histology with the FNAC result. Patient anxiety was measured by the State Trait Anxiety Inventory at 6 moments during the diagnostic workup.Of the 131 included patients, 112 (86%) were female, and the mean age was 53 years. All patients, except those with a nondiagnostic FNAC result (n = 26; 20%), had a diagnosis at the end of the day. There were only two discordant results. Anxiety levels at the beginning of the day were high throughout the group, State Trait Anxiety Inventory (STAI) score 43.1 (SD 2.0) and decreased significantly more in patients with a benign FNAC result (STAI score 30.2), compared to patients with a malignant or indeterminate result (STAI score 39.6).Distress of patients with a thyroid nodule undergoing same-day FNAC diagnostics was high. Same-day FNAC diagnosis is feasible and accurate for the evaluation of thyroid nodules. Therefore, same-day FNAC diagnosis seems a safer, more patient-friendly approach to diagnose thyroid nodules.

BACKGROUND Cell block (CB) techniques for fine-needle aspiration biopsies (FNABs) vary. A direct comparison of CB techniques with statistical validation was performed to identify the best method. METHODS Three CB techniques were compared: 1) FNAB rinsed in saline and clotted with plasma and thrombin (SPT); 2) FNAB rinsed in formalin and clotted with HistoGel (HG); and 3) FNAB rinsed in formalin, centrifuged, and the pellet captured in a collodion bag (ColB). FNAB was performed on 35 random surgical specimens for smears and each CB technique. A randomized blinded review of hematoxylin and eosin-stained CB slides was performed and each case was scored on a scale of 1 to 3 for cellularity, preservation, and architecture and the overall best CB was identified. Significance was determined by the Mann-Whitney U test for nonparametric ordinal data. RESULTS The mean cellularity score was 1.71 for SPT (standard deviation [SD], 0.89), 1.68 for HG (SD, 0.67), and 3.0 for ColB (SD, 0). The mean preservation score was 1.31 for SPT (SD, 0.58), 1.54 for HG (SD, 0.70), and 2.91 for ColB (SD, 0.37). The mean architecture score was 1.45 for SPT (SD, 0.70), 1.43 for HG (SD, 0.60), and 2.71 for ColB (SD, 0.57). There was no statistical significance noted between SPT or HG when compared for each category. ColB was found to be superior to both SPT and HG when compared for each category (P

Background Thyroid cancer is the most common endocrine cancer, and its incidence has been increasing worldwide in the past decades. The increasing demand in medicine for rapid and accurate diagnosis enabled the application of digital imaging analysis in order to increase workflow efficiency and accurate analyses. The present study aimed to automatically differentiate papillary thyroid carcinoma from normal thyroid cells using high-throughput image analysis. Methods Images of cellular specimens were taken with a digital camera and were subsequently analyzed. Other software was used for machine-learning-based cellular diagnostics. Results The two different classes were correctly identified with high sensitivity and specificity. Conclusion The data created offers great potential for an automated diagnosis. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.

Resume Introduction L’echo-endoscopie bronchique (EEB) est une technique recente pour le diagnostic et la classification ganglionnaire des cancers bronchiques. Elle a aussi montre son interet dans le diagnostic des adenomegalies mediastino-hilaires d’etiologies autres. Cette etude rapporte les trois premieres annees d’experience de notre centre en termes d’usage pratique de l’echo-endoscopie bronchique comme nouvel outil diagnostique dans ce domaine. Methodes Etude retrospective des cas consecutifs de patients ayant beneficie d’une echo-endoscopie bronchique de novembre 2008 a juin 2011 au centre hospitalier Lyon-Sud (CHLS). Resultats Sur les 65 echo-endoscopies bronchiques, une anesthesie generale a ete pratiquee dans 89 % des cas, avec une bonne tolerance dans 81 % des cas. Dans 77 % des cas, l’EEB a permis d’etablir le diagnostic permettant d’eviter la mediastinoscopie dans 60,5 % des cas. Les valeurs respectives de la sensibilite, specificite, valeurs predictives positives (VPP) et negatives (VPN) etaient de 74 %, 100 %, 100 % et 48 %. Conclusions Ces donnees, reflet de l’experience d’une equipe debutante, illustrent les resultats obtenus dans la pratique courante en termes d’etiologie diagnostique. L’EEB semble ainsi promise a un bel avenir mais necessite le developpement de centres dedies permettant la formation de pneumologues et d’anatomopathologistes specialises dans ce domaine.

Echinococcosis or hydatid disease (HD) is a parasitic disease caused by species of the Echinococcus genus. Since the incidence of HD in the USA is very low and the primary HD of the thyroid is extremely rare even in endemic regions, the occurrence of primary thyroid HD is exceptional in the USA. Thyroid HD is rarely diagnosed by fine-needle aspiration (FNA). Our literature review revealed less than ten cases of primary HD of thyroid diagnosed by FNA worldwide. Hereby, we report the first case of a primary thyroid HD diagnosed by fine-needle aspiration in the USA.

Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.

Resumen Introduccion La atipia de significado incierto o lesion folicular de significado incierto (categoria iii del sistema de Bethesda, 2007) tiene una prevalencia de malignidad variable en los distintos estudios (5-37%), y por tal motivo no existe en la actualidad un consenso sobre el manejo adecuado de este resultado: repetir PAAF o cirugia. El objetivo del siguiente trabajo es analizar el riesgo de malignidad en nuestro medio de dichos nodulos para determinar la actitud clinica mas adecuada. Material y metodos Desde la implantacion del sistema Bethesda en el Hospital Xeral de Vigo (enero de 2011) hasta septiembre de 2014 se analizaron 431 citologias, de las cuales el 7,1% (32/430) fueron etiquetadas de categoria iii . Se reviso el resultado de la segunda citologia cuando se repitio la PAAF y el resultado histologico posquirurgico de los operados. Resultados En 23 (82,1%) pacientes se indico la realizacion de una tiroidectomia y en los 5 restantes (17,9%), la repeticion de la PAAF. La citologia resulto benigna (categoria ii ) en 3 de ellos (60%) e insatisfactoria (categoria i ) en 2 (40%). De los 25 pacientes tiroidectomizados, incluidos los 2 operados tras el resultado de la segunda PAAF, las piezas quirurgicas de 13 (52%) fueron benignas y las de otros 12 (48%) demostraron un carcinoma diferenciado de tiroides: 10 (83,3%) con cancer papilar de tiroides, uno (8,3%) con cancer folicular de tiroides y uno (8,3%) con cancer papilar con areas de patron folicular. En nuestros pacientes el riesgo de malignidad de las citologias calificadas como categoria iii esta entre el 42,9 y el 48%. Conclusion Recomendamos que todos los pacientes con citologias categoria iii de Bethesda se sometan a tiroidectomia.

Thyroid radiology practice is a medical practice in which thyroid diseases are diagnosed using imaging modality and treated by imaging-based interventional techniques, and the primary care target is thyroid nodular disease. Diagnosis of thyroid nodules is primarily done by ultrasound imaging and biopsy; thyroid nodules can be treated by non-surgical interventional treatment and thyroidectomy. Ethanol ablation is the first-line treatment for cystic benign nodules, and radiofrequency ablation is used for the treatment of benign solid nodules and recurrent thyroid cancers. Thyroid radiology practice has an essential clinical role in diagnosis and non-surgical treatment of thyroid nodular diseases, and treatment should be performed based on standard care guidelines for proper patient care. In order to provide the best care to patients with thyroid nodular disease, it is desirable to treat patients in the radiology outpatient clinic. Thyroid radiology practice centered on outpatient clinic practice needs to be expanded.

Purpose The objective of this study was to evaluate the diagnostic value and threshold levels of cytokeratin fragment 21-1 (CYFRA 21-1) in fine-needle aspiration (FNA) washouts for detection of lymph node (LN) recurrence in postoperative breast cancer patients. Materials and Methods FNA cytological assessments and CYFRA 21-1 measurement in FNA washouts were performed for 64 axillary LNs suspicious for recurrence in 64 post-operative breast cancer patients. Final diagnosis was made on the basis of FNA cytology and follow-up data over at least 2 years. The concentration of CYFRA 21-1 was compared between recurrent LNs and benign LNs. Diagnostic performance and cut-off value were evaluated using a receiver operating characteristic curve. Results Regardless of the non-diagnostic results, the median concentration of CYFRA 21-1 in recurrent LNs was significantly higher than that in benign LNs (p < 0.001). The optimal diagnostic cut-off value was 1.6 ng/mL. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CYFRA 21-1 for LN recurrence were 90.9%, 100%, 100%, 98.1%, and 98.4%, respectively. Conclusion Measurement of CYFRA 21-1 concentration from ultrasound-guided FNA biopsy aspirates showed excellent diagnostic performance with a cut-off value of 1.6 ng/mL. These results indicate that measurement of CYFRA 21-1 concentration in FNA washouts is useful for the diagnosis of axillary LN recurrence in post-operative breast cancer patients.

Molecular testing has reduced the need for diagnostic hemithyroidectomy for indeterminate thyroid nodules. No studies have directly compared molecular testing techniques.Compare the diagnostic performance of Afirma Gene Expression Classifier (GEC) with that of ThyroSeq v2 next-generation sequencing assay.Parallel randomized trial, monthly block randomization of patients with Bethesda III/IV cytology to GEC or ThyroSeq v2.University of California, Los Angeles.Patients who underwent thyroid biopsy (April 2016 to June 2017).Testing with GEC or ThyroSeq v2.Molecular test performance.Of 1372 thyroid nodules, 176 (13%) had indeterminate cytology and 149 of 157 eligible indeterminate nodules (95%) were included in the study. Of nodules tested with GEC, 49% were suspicious, 43% were benign, and 9% were insufficient. Of nodules tested with ThyroSeq v2, 19% were mutation positive, 77% were mutation negative, and 4% were insufficient. The specificities of GEC and ThyroSeq v2 were 66% and 91%, respectively (P = 0.002); the positive predictive values of GEC and ThyroSeq v2 were 39% and 57%, respectively. Diagnostic hemithyroidectomy was avoided in 28 patients tested with GEC (39%) and 49 patients tested with ThyroSeq v2 (62%). Surveillance ultrasonography was available for 46 nodules (45 remained stable).ThyroSeq v2 had higher specificity than Afirma GEC and allowed more patients to avoid surgery. Long-term surveillance is necessary to assess the false-negative rate of these particular molecular tests. Further studies are required for comparison with other available molecular diagnostics and for newer tests as they are developed.

There may exist an association between thyroid dysfunction/autoimmunity and parity. Autoimmune thyroiditis shows some degree of telomere shortening. Parity was recently found to be associated with telomere shortening. We hypothesize that among the factors affecting the tentative association between parity and thyroid dysfunction/autoimmunity shortened telomeres' may also be implicated. This could also be another facet of the processes leading to autoimmune thyroiditis.

Introduction Fine-needle aspiration (FNA) is the most accurate diagnostic approach for determining thyroid nodule malignancy. Most nodules are benign, therefore, only suspicious ones require FNA. In 2017 American College of Radiology proposed a scoring system – Thyroid Imaging, Reporting and Data System (TI-RADS) for identifying clinically significant malignancies. Whether a nodule requires FNA depends on various criteria, one of which is the size. The aim of this study was to determine whether size is an important factor in deciding the necessity for FNA. Methods A total of 288 ultrasound images of patients with thyroid nodules were analysed. The nodules were scored, measured and assigned to one of five TI-RADS levels (TR): TR1 – benign, TR2 – not suspicious, TR3 – mildly suspicious, TR4 – moderately suspicious, TR5 – highly suspicious. The results were compared with histology findings. Results 219/288 (76%) benign and 69/288 (24%) malignant thyroid nodules were verified histologically. Nodules were distributed as follows: TR1 – 17 (5.9%), TR2 – 27 (9.4%), TR3 – 72 (25.0%), TR4 – 126 (43.8%), TR5 – 46 (16.0%). The mean size of measured nodules was 2.05G1.02 cm. In categories TR1 and TR2 100% of nodules were benign according to FNA. In TR3 68/72 (94.4%) of nodules were benign and 4/72 (5.6%) malignant, 38/72 (52.7%) !2.5 cm in size and 34/72 (47.22%) – R2.5 cm. None of the malignant nodules in TR3 were R2.5 cm. Negative correlation (rs ZK0.298, PZ0.011) was found between size and malignancy. In TR4 93/126 (73.8%) of nodules were benign and 33/126 (26.2%) malignant, 59/126 (46.8%)!1.5 cm in size and 67/126 (53.2%) –R1.5 cm. Size of R1.5 cm had sensitivity of 39.39%, specificity of 41.94%, positive predictive value (PPV) of 19.40%, negative predictive value (NPV) of 66.10% and accuracy of 41.27%. No significant correlations between size and malignancy in TR4 were found. In TR5 14/46 (30.4%) of the nodules were benign and 32/46 (69.6%)

Objective To describe the results of endobronchial ultrasound-guided transbronchial needle aspiration in making diagnosis of mediastinal injuries associated to different causes. Methods A retrospective cross-sectional study of patients submitted to Endobronchial ultrasound-guided transbronchial needle aspiration at a private organization, between June 2013 and October 2016. All cases referred for collection of lymph nodes or peritracheal/peribronchial masses by endobronchial ultrasound-guided transbronchial needle aspiration, and evaluated through tomography or PET-CT were included. Interventional pulmonologists and thoracic surgeons with experience in the method did the procedures. Rapid on-site evaluation of fine needle aspiration was performed by an experienced pathologist. Material analysis included cytological smear and cytopathological analysis of paraffin-embedded cell blocks. Other specific analyses (immunocytochemistry, tests and cultures of infectious agents) were performed whenever necessary. Results We included 72 patients; 6 were excluded for presenting endobronchial lesions in which bronchoscopic biopsy could be performed, or intrathoracic lesions that were not accessible by endobronchial ultrasound-guided transbronchial needle aspiration. The mean age of 66 patients included for analysis was 61.17 years (±14.67 years), with a predominance of males (64%). Endobronchial ultrasound-guided transbronchial needle aspiration was definitive for diagnosis in 60 cases (91%). Three cases (4.5%) had inconclusive test results. There were no major complications related to the procedure. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration had a high diagnosis yield, with minimal morbidity, being an excellent option for diagnostic approach of patients with lymphadenopathy or intrathoracic lesions, and for neoplasm staging. RESUMO Objetivo Descrever os resultados da utilização de punção aspirativa por agulha guiada por ultrassom endobrônquico na definição do diagnóstico em casos de lesões mediastinais por diferentes causas. Métodos Estudo transversal retrospectivo de pacientes submetidos à punção aspirativa por agulha guiada por ultrassom endobrônquico em instituição privada, entre junho de 2013 e outubro de 2016. Foram incluídos todos os casos referenciados para coleta de materiais de linfonodos ou massas peritraqueais/peribrônquicas por punção aspirativa por agulha guiada por ultrassom endobrônquico, estudados com tomografia ou PET-CT. Os procedimentos foram realizados por pneumologistas intervencionistas e cirurgiões torácicos com experiência no método. Rapid on-site evaluation da punção aspirativa por agulha fina foi realizada por patologista experiente. A análise do material incluiu citologia dos esfregaços em lâminas e análise citopatológica do emblocado celular. Outras análises específicas (imunocitoquímica, pesquisas e culturas de agentes infecciosos) foram realizadas se necessárias. Resultados Foram incluídos 72 pacientes; destes, 6 foram excluídos por apresentarem lesões endobrônquicas passíveis de biópsia broncoscópica convencional ou lesões intratorácicas não acessíveis a punção aspirativa por agulha guiada por ultrassom endobrônquico. Assim, a média de idade dos 66 pacientes incluídos para análise foi 61,17 anos (±14,67 anos), com predomínio do sexo masculino (64%). A punção aspirativa por agulha guiada por ultrassom endobrônquico foi definitivo para o diagnóstico em 60 casos (91%). Três casos (4,5%) foram inconclusivos. Não houve complicações maiores relacionadas ao procedimento. Conclusão A punção aspirativa por agulha guiada por ultrassom endobrônquico teve elevado rendimento diagnóstico, com mínima morbidade, constituindo excelente opção na abordagem diagnóstica de pacientes com linfadenopatia ou lesões intratorácicas e no estadiamento de neoplasias.

Introduction: The methods available for the diagnosis of thyroid nodules include physical examination, imaging, laboratory and fine-needle aspiration cytology tests. Aim: The aim of this study was to determine the quality assurance of fine-needle aspiration cytology of thyroid nodules. Method: Cytology results were rated to 6 categories according to the Bethesda System for Reporting Thyroid Cytopathology (2008) (I. nondiagnostic; II. benign; III. atypia of undetermined significance; IV. follicular neoplasia; V. suspicious for malignancy; VI. malignant). All cytology reports were compared with the final histology diagnosis. Results: A total of 1384 patient with thyroid nodule underwent fine-needle aspiration biopsy cytology. Smears were classified I. inadequate in 214 (15.9%); II. benign 986; III. atypical 56; IV. follicular neoplasm 41; V. suspicious for malignancy 18; VI. malignant 33 cases. Two hundred and twenty seven (16.8%) of the cases were operated and histologically verified. The positive predictive value in the benign category was 98.25% and in the malignant 88.46%. The sensitivity of the follicular neoplasm was 66.67%. Conclusion: The results suggest that fine-needle aspiration cytology of thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology has a high diagnostic accuracy. The auditing values of the results meet the proposed threshold values. Orv. Hetil., 2015, 156(41), 1661–1666.

BACKGROUND Cytologic findings of pancreatic oncocytic-type intraductal papillary mucinous neoplasms (IPMNs)/intraductal oncocytic papillary neoplasms (IOPNs) are largely unknown.

Background Indeterminate (atypical/suspicious) fine needle aspiration (FNA) interpretation of Pancreatic Neuroendocrine Tumor (PanNET) can be frustrating for both pathologists and clinicians. Although published literature has often addressed the significance of indeterminate cytologic diagnoses in non-neuroendocrine epithelial lesions, the significance of indeterminate FNA results for PanNET is less established. Methods The pathology records of The Johns Hopkins hospital were searched for histologic diagnoses of PanNET that had corresponding pre-operative FNA results. Cytopathologic diagnoses were categorized according to the index of suspicion described in the report (atypical, suspicious for PanNET and PanNET). Additionally, the exact reasons for the indeterminate nature of the diagnoses—such as lack of adequate cytologic features, unusual findings, or lack of confirmatory immunocytochemistry (ICC) were investigated. Results One hundred and twenty (120) cases of PanNET were identified. Of these, the FNA diagnoses were as follows: 78% (94/120) were PanNET, 9% (11/120) were suspicious for PanNET, 6% (7/120) were atypical, 4% (5/120) were benign, 2% (2/120) were non-diagnostic and 1% (1/120) was called a mucinous neoplasm. Of the 94 cases that were definitively PanNET, 74 (78%) required ICC for the diagnosis. Of the 26 cases that were not diagnosed definitively as PanNET, 73% (19/26) were morphologically suggestive of PanNET but did not have sufficient material for confirmatory ICC. Conclusions ICC is commonly employed to confirm the cytologic suspicion for PanNET. The most common reasons for indeterminate diagnoses were a quantitative lack of lesional cells and lack of material for confirmatory ICC. Diagn. Cytopathol. 2016;44:10–13. © 2015 Wiley Periodicals, Inc.

Advances in the molecular characterization of thyroid cancers have fueled the development of genetic and gene expression-based tests for thyroid fine-needle aspirations. Collectively, these tests are designed to improve the diagnostic certainty of thyroid cytology. This review summarizes the early published experience with the commercially available versions of these tests: the Afirma Gene Expression Classifier, ThyGenX (formerly miRInform)/ThyraMIR, and ThyroSeq. Key differences in testing approaches and issues regarding test performance and interpretation are also discussed.

Wstep: Celem niniejszego badania bylo porownanie diagnostycznej wydajności probek guzkow tarczycy otrzymanych metodą biopsji aspiracyjnej lub kapilarnej, wykonanej za pomocą igiel nr 22 lub nr 27 z lub bez analizy cytologicznej przeprowadzonej na miejscu. Materialy i metody: Czterystu pacjentow z guzkami tarczycy poddano biopsji cienkoiglowej pod kontrolą USG. Pacjentow podzielono na osiem grup, wedlug wielkości zastosowanych igiel (nr 22 vs. nr 27), techniki biopsji (aspiracyjnej kontra kapilarnej), a takze przeprowadzonej lub nie analizy cytologicznej na miejscu. Wskaźniki wydajności probek obliczono dla kazdej grupy i podgrupy oraz porownano je za pomocą testu chi-kwadrat. Wyniki: W grupie wszystkich ocenianych guzkow (n = 400), wskaźnik wydajności byl znacznie wyzszy w grupie badanej techniką kapilarną niz w grupie badanej metodą aspiracyjną (97% vs. 91,5%, p = 0,032). Wskaźnik wydajności byl rowniez wyzszy, gdy przeprowadzono analize cytologiczną na miejscu niz gdy jej nie przeprowadzono (97% vs. 91,5%, p = 0,032). Wśrod guzkow litych (n = 205), wskaźnik wydajności rowniez osiągnąl wyzszą wartośc w grupie badanej techniką kapilarną wzgledem grupy badanej techniką aspiracyjną (98,9% vs. 89,7%, p = 0,008), oraz gdy przeprowadzono analize cytologiczną na miejscu (97,9% vs. 89,6%, p = 0,014). Inaczej niz dla powyzszych wynikow, wskaźnik wydajności byl podobny dla igiel nr 22 i nr 27 (94,2% vs. 93,1%, p = 0,733). Wnioski: Wyniki optymalne uzyskano techniką kapilarną oraz wykonując analize cytologiczną na miejscu. Technika kapilarna oraz analiza cytologiczna na miejscu powinny stanowic preferowane podejście w biopsji guzkow tarczycy, optymalizując wskaźnik wydajności oraz samopoczucie pacjenta. (Endokrynol Pol 2015; 66 (4): 295–300)

Polyacrylamide gel (PAAG) injection remains an uncommon method of breast augmentation. Providers must recognize the clinical and radiological manifestations to optimize management. The clinical and radiological findings of PAAG injection may mimic malignancy and silicone breast augmentation. We described two patients with prior PAAG breast augmentation with physical exam and imaging findings concerning for malignancy. We reviewed the literature on PAAG breast augmentation and compare PAAG to silicone breast augmentation. The management of such patients is discussed.

To assess whether a dedicated "1-stop" neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC.Retrospective review.District General Hospital in the United Kingdom.Patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed in 4 groups: group 1, FNAC performed by any of the subspecialist radiologists with cytology support (n = 100); group 2, FNAC performed by general radiologists without cytology support (n = 112); group 3, FNAC performed by a particular subspecialist radiologist with cytology support (n = 61); and group 4, FNAC performed by the same subspecialist radiologist without cytology support (n = 125).There was a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist with immediate cytology (group 1) versus a general radiologist without cytology support (group 2; 87/100 vs 63/112, P = .0001), a significantly higher rate of adequacy of FNAC in the presence of cytology support with the same radiologist (group 3 vs group 4, 55/61 vs 97/125, P = .04), and a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist versus a general radiologist without cytology support (group 4 vs group 2, 97/125 vs 63/112, P = .0005).Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of non-cytology-supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.

This is an unusual presentation of metastatic mesothelioma presenting as a breast lump and mimicking a primary tumour at that site.